Asheville VA not suffering from woes of Phoenix

Delays in Asheville VA admissions cut by doubling the number of employees in admissions and scheduling

Duane Duren, a medical support assistant at the Charles George VA Medical Center, says he takes his admissions and scheduling job very seriously, in part because he’s an Air Force veteran himself.
(Photo:
John Boyle
,
jboyle@citizen-times.com
)

ASHEVILLE – With Veterans Affairs hospitals nationwide rocked by revelations of poor patient care and efforts to cover up delays by fudging paperwork, administrators with the local VA hospital want to send a clear message to patients and their families.

"We don't game the system," said Bob Downs, chief of health administrative service at the Charles George VA Medical Center in east Asheville. "You report what is reportable. We can't fix the problem unless we know there is a problem."

The scope of the misconduct at some VA hospitals erupted in recent weeks, centering around inappropriate handling of veterans files and records at the Phoenix hospital. A VA inspector general found that 1,700 veterans in Phoenix were removed from any official patient lists and kept waiting for appointments, sometimes for longer than six months.

Inspectors have found other VA hospitals also have suspect statistics and records, with patient care lacking. VA Secretary Eric Shinseki resigned Friday, saying he took personal responsibility for systemic delays in care.

"We now know that VA has a systemic, totally unacceptable lack of integrity within some of our veteran health facilities," Shinseki said. "The breach of trust involved the tracking of patient wait times for appointments."

Downs and other Charles George VA officials said the Asheville facility is not among those with poor marks for efficiency in seeing veterans, or for the quality of care they offer. The Charles George VA serves 20 Western North Carolina counties, handling about 37,000 appointments each month.

A four-member VA audit team from Ohio visited the Charles George VA two weeks ago, spending two days interviewing staff and poring over figures, including the 14-day admission numbers, Downs said. That's a key figure for VAs and tracks the percentage of new or transfer patients who are seen in initial appointments within 14 days, after being approved for eligibility.

"When they left, they said we were the benchmark," Downs said of the auditors. "They said of the teams they saw that week, which was a total of five teams, they said we were a best practice. That was the informal debriefing we received, not the formal one."

That formal report will come out Friday.

Increasing staff, decreasing waits

The local VA acknowledges that its wait times were worse several years ago, but they've made a concerted effort to improve them, doubling staff that handle admissions and appointments.

Local veterans have noticed.

"I've been going to the VA hospital in Asheville since 1957, and I've seen a lot of change," said Bill Edwards, 79, who now lives in Andrews but lived in Asheville for decades. "I can't see why anybody would complain about the VA hospital in Oteen."

One key federal benchmark is that no more than 2 percent of veterans should have to wait more than 14 days for an initial appointment with a doctor. The local VA has seen tremendous improvement in that area, according to Andrew Fortner, health systems and quality management specialist at the Charles George VA.

"Five years ago it was very difficult for us to meet that measure," Fortner said. "Now we've consistently met it over the past two years, as far as getting those patients seen. A lot of that is scheduling accuracy, and the full-time employees increase so we're able to see those veterans as the demand increase."

The number of local veterans seeking treatment has increased 12 percent over the past five years. Downs, a retired Marine, said when he joined the VA nearly three years ago, the need for more staffers was obvious, and he made the case to Director Cynthia Breyfogle and other hospital leaders. Breyfogle joined the Charles George VA in 2010.

At that time, they had fewer than 30 staffers in the admissions and scheduling department, a number that now stands at 62.5 full-time equivalents, or positions. That's a $1.5 million investment, and the VA also overhauled its training and evaluation processes to ensure those workers are getting the job done.

That 14-day appointment number — the percentage of veterans seen beyond that time frame — now stands at 1.3 percent, well under the 2 percent federal threshold, Fortner said. Some veterans do not want to be seen within two weeks, he noted. The Asheville VA met that threshold in 2012 and 2013.

The local VA does even better on consultation visits, in which a primary care physician refers a patient to a specialist. Charles George VA had 160,000 consults last year, and only about .5 percent of those waited longer than 14 days to be seen.

Phone service problems

Edwards said his appointments are always prompt, and he's a huge fan of his doctor.

"The only small problem you have there is trying to get through to somebody on the phone," Edwards said. "It used to be really, really bad. I used to make a phone call there, and I'd say I'd stay on the phone and by the time someone would answer I could drive up there."

That, too, has been an area of emphasis for administrators.

Dave Lappie, supervisor of medical support assistance and health administration service, said phone service was one of "the first metrics we worked on.

"We knew that was a major source of frustration to veterans," he said, referring to the abandonment rate, or number of veterans who hang up out of frustration. "We started out with a pretty hefty abandonment rate, but through staffing and leadership, we've been able to reduce that abandonment rate to below 5 percent."

It had averaged 12-20 percent, but is now around 4 percent, and most callers are answered within 30 seconds.

Trying to stay ahead of demand

The number of patients the local VA serves continue to increase. In 2010, the center served 33,500 veterans, and with more soldiers returning from Afghanistan and plenty of retirees moving to WNC, the local VA expects patient load to grow another 11 percent by 2016.

Nationally, the VA has struggled to keep up with a huge increase in demand. About 9 million veterans are now enrolled in the VA health care system, about 1 million more than six years ago, with much of that influx from returning Iraq and Afghanistan veterans and aging Vietnam War vets.

To help streamline the process, local VA officials encourage veterans to register for treatment as early as possible and not to wait until they're acutely ill. Once a veteran comes into the VA, they have to determine eligibility, which requires filling out a form that is sent electronically to the Health Eligibility Center in Atlanta, then returned, usually a 2-3-day process.

If approved, the local VA then enters the veteran in its system and begins the tracking process. The hospital's new patient scheduler then begins the appointment scheduling process and gets the patient set up with a primary care doctor.

The Charles George VA uses the PACT system, or Patient Aligned Care Team, meaning the patient will be assigned to one doctor, nurse and other staffers to improve care and continuity. The local VA has also received high ratings nationally on its PACT program, according to Dr. Paul Riggs, a primary care physician and assistant chief of the primary care department.

"I can speak from a primary care viewpoint, and we don't have an access problem," Riggs said, who spent 17 years in the private sector before joining the VA 10 years ago. "All I can tell you from my experience is that we have an executive leadership team here that is so pro-patient, I've never really seen anything like it before."

With 27 physicians total in primary care and outpatient, Riggs said he feels the hospital is adequately staffed.

"But I don't know what the next few years will show," Riggs said. "We try to stay ahead of the curve."

'I take it personally'

Fortner noted that Charles George is part of Division 6 in the VA system, which includes North Carolina, Virginia and part of West Virginia. The division is one of the fastest growing in the country over the past five years.

Usually, the Charles George VA ranks first or second in the nation for patient satisfaction scores, and that's out of 152 medical centers nationwide, he said. For the year to date, the center's outpatient satisfaction score is 89.1 percent, 87.9 percent for inpatient. Both exceed the set target.

"I've had nothing but great experiences at that VA, and most of they guys I know say the same thing," said Trevor Nash, a Vietnam veteran who moved to the Asheville area eight years ago from California. "The only thing I've ever waited on is I had to get an eye exam and they were backed up, so they outsourced me. But still, it was all, 'Boom, boom, boom. Quick."

Duane Duren, a medical support assistant, is one of those employees who makes the booming happen. Working the scheduling desk last week, he said he wants each and every veteran to feel like they're getting top-notch service.

"I take it personally myself, because I'm a veteran myself," said Duren, who spent 20 years in the Air Force.

Fortner, Lappie and Downs said all VAs come under pressure to perform better, to improve their 14-day numbers and offer better customer service. But they also insisted they will not falsify data in that quest.

"It all comes down to character and integrity and doing what's right for the veterans," Downs said. "Because most of us that work in this service line are veterans, we're not going to (compromise) our integrity. We're going to do what's right for the veterans. We're going to fight the fight."

USA Today and the Associated Press contributed to this story.

Charles George VA Medical Center, by the numbers

• $303.6 million budget this year.

• 37,000 outpatient appointments in April.

• 36,458 patients last fiscal year.

• 1,700 employees, 35 percent of them veterans.

• 119-bed acute care hospital beds, 120 in the community living center

• 89.1 percent outpatient satisfaction score.

• 87.9 percent inpatient satisfaction score.

• 1.3 percent of veterans not seen within 14 days, below the target goal of 2 percent.

Source: Charles George VA Medical Center

Need help?

If you're a local veteran and want to enroll in VA health care through the Charles George VA Medical Center, or if you're having trouble with your enrollment, call the local VA Medical Center at 296-4462.